Zackrisson Sophia, Lindström Martin, Moghaddassi Mahnaz, Andersson Ingvar, Janzon Lars
Department of Clinical Sciences, Malmö University Hospital, Malmö, Sweden.
Scand J Public Health. 2007;35(5):548-54. doi: 10.1080/14034940701291716.
Rate of non-attendance following invitation for breast cancer screening is related to several socioeconomic conditions. To what extent this reflects differences with regard to individual and environmental circumstances, respectively, has received little attention. The purpose of this study was to investigate the effect of individual socioeconomic and area-level determinants on variations in non-attendance among geographic areas in an urban mammographic service screening programme.
The study population consisted of 32,119 women invited for mammographic screening in 1990-93, residing in 97 neighbourhoods in the city of Malmö in Sweden. The influence of the individual factors age, marital status, education, housing accommodation, household income, and area-level circumstances, e.g. rate of migration and rate of being gainfully employed, on the rate of non-attendance was assessed by multilevel analysis.
Area rates of nonattendance ranged from 18% to 63%. Of the total variability in non-attendance, 4.3% was between neighbourhoods. This effect was significantly reduced when adjusting for the individual factors. The area-level factors, migration, and rate of being gainfully employed reduced and almost erased the neighbourhood variance in non-attendance.
In addition to individual socioeconomic factors, area-level factors seem to be important determinants of neighbourhood rates of non-attendance in an urban mammographic screening programme. In a public health perspective neighbourhoods may be targeted in order to affect the problem of non-attendance in mammographic screening.
乳腺癌筛查邀请后的未参加率与多种社会经济状况相关。而这在多大程度上分别反映了个体和环境状况的差异，却很少受到关注。本研究的目的是调查个体社会经济因素和地区层面的决定因素对城市乳腺钼靶筛查项目中各地理区域未参加率差异的影响。
研究人群包括1990 - 1993年被邀请进行乳腺钼靶筛查的32119名女性，她们居住在瑞典马尔默市的97个社区。通过多水平分析评估个体因素年龄、婚姻状况、教育程度、住房条件、家庭收入以及地区层面的状况，如移民率和就业比率对未参加率的影响。
未参加率的地区范围在18%至63%之间。在未参加率的总体变异性中，4.3%存在于社区之间。在对个体因素进行调整后，这种影响显著降低。地区层面的因素、移民和就业比率降低并几乎消除了社区在未参加率方面的差异。
除了个体社会经济因素外，地区层面的因素似乎也是城市乳腺钼靶筛查项目中社区未参加率的重要决定因素。从公共卫生角度来看，可以针对社区来解决乳腺钼靶筛查中的未参加问题。
